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Are cardioselective beta-blockers helpful, harmful, or neutral in patients with chronic obstructive pulmonary disease (COPD) who don’t have compelling cardiovascular (CV) indications for their use? Researchers have posed this question for two reasons. First, patients with COPD are at above-average risk for adverse CV events that beta-blockers might prevent. And second, observational studies have suggested that cardioselective beta-blockers might actually lower risk for COPD exacerbations. However, two previous randomized trials — one with metoprolol and the other with bisoprolol — have failed to confirm these theoretical benefits.
Nearly 300 patients with COPD who had at least one treatment-requiring exacerbation within the previous 2…